AMPLIFIEDD (A MODIFIED VERSION OF THE “AMPLE HX”)
DESIGNED AND DEVELOPED FOR ORAL BOARD SIMULATIONS
© 1989-2019 Dwight Collman, MD DABEM, DABFM
This is a worst case scenario for the presenting history; the EXRs have the data you need. You MUST ASK the questions or use your resources as listed below in the Q/A discussion below. Every type of simulation exists, i.e., those in which patients may die during the care is possible. No history was available. Simply do what you would normally do. (Talk to the family and call for grief counseling). Just because a patient died under your care does not mean you failed a case and the board would not want you to feel this stress during such an examination in general because most cannot function if they are told this during a live board certification examination. So typically no one dies [meaning you ar not informed of that by EXRs…I think you know what I mean}….DDC.
P ast medical/surgical problems:
• PMH: Unknown.
• Recent PMHx: Unknown.
• ROS (ONLY THE CASE RELATED SYSTEMS REVIEW): Unknown.
• Social Hx: Unknown.
• Past surgery: Unknown.
L ast meal:
I mmediate events:
• As indicated above.
F amily, friends or family doctor:
• Unable to contact parents (they were transported to another hospital).
E MTs or paramedics:
• As indicated above.
D octor to admit/refer:
• Dr. Trauma Surgeon and Dr. Burn Surgeon at the burn center. [The patient will require transfer to the burn center].
D ocuments (old records):
• None available.
Here I will introduce you to my abbreviated version of writing called: “Density” D4 is a very compressed form of the use of language. I will use it as the web site develops over time and you get used to me Years ago I read that once you reach a university level there is no need for proper spelling to transmit the same information. Look at mathematics! To most it looks like gibberish but it is just symbols to compress what would otherwise take up even more space. I use D [DensityTM] throughout my writing to decrease the amount of reading. It should be obvious to most of you since this is not unlike what you do when you text each other.
Q: WHO ARE THE PROFESSIONALS YOU MIGHT INTERACT WITH OR RESOURCES YOU MIGHT USE IN CLINICAL PRACTICE…EXRS MIGHT SAY THEY DON’T HAVE INFORMATION AS ABOVE…HOW CN U NAVIGATE THS [THIS] PROB?…THS IS REQUIR’D AS “PROBLEM SOLVING” = ⅛ F UR SCORE
A: OLD RECORDS, IMMEDIATE FAMILY MEMBERS IN T ED, T PCC [POISON CONTROL CENTER], T PHARMACY, T PATIENT’S PILL BOTTLES, EVEN SENDING SOMEONE BACK TO T SCENE TO GET T PT’S MEDS IF NEEDED. TREATING T PT EMPIRICALLY BASED ON SIGNS AND SXS MAY BE ALL YOU CAN DO…BT T KEY TO ALL AMS CASES IS IN T HX! DONT JUST KEEP GIVING A DRUG IF A PT IS SZING! DILANTIN IN OD CN CAUSE SZRS. INH SZRS REQUIRE A SPECIFIC ANTIDOTE [PYRIDOXINE IN UP TO 5G DOSES Q 30 MIN].
FINALLY, A MEDICAL ALERT TAG WHICH U FIND WHN U UNDRSS T PT [E IS FOR EXPOSE IN T PRIMARY SURVEY. A REPEAT RAPID PRIMARY/SECONDARY SURVEY IS HOW YOU FIND A MISSED CA OR MISSED INJURY OR MISSD ILLNESS]…EXRs R ONLY ALLOWED TO ASK, “ANYTHING ELSE” IF YOU SAY NO TO AN EXR 3 X’S & MISS’D SOMETHING THY GAVE YOU AMPLE OPPORTUNITY.
THIS IS JUST LIKE A COURTROOM: IF YOU ARE EXCUSED & NOT ASKED A “PATHO Q” BY YOUR “EXR JUDGE” ITS BCAUS UR ACTNS PROV’D U KNEW T PATHO…ALL DEFENDANTS NOT ALLOWE TO DEFEND THEMSELVES IN COURT ARE RELEASED BCAUS T STATE [JUDGE] OR PROSECUTER] DECIDES THY HV NO CASE AGAINST THT DEFENDANT. SO WHEN A JUDGE ORDERS A DEFENSE TO DECIST IT IS A GOOD THING…IT MEANS T DEFENDANT IS GOING TO BE RELEASED [THT IS BASED ON US LAW]. THS IS A SCORE RELATED TO YOUR CLINICAL ACUMEN/JUDGEMENT & KNOWLEDGE OF BOTH PATHO (PHYSICAL PRESENTATIONS [SXS AND SIGNS] AND LIFE THREATENING V SIGNS OR EVN COMPARISON W/A RECENT PRIOR EKG OR CXR. ANY OF THS DATA MAY B AVAILABLE, BT U MST ASK FOR EACH ITEM!.
WE OFTEN DON’T REALIZE HOW MUCH INFO WE PROCESS IN A DAY…DDC.